Solitary pulmonary caseating granulomas: A 5‑year retrospective single‑center analysis

Watanabe,Hidehiro; Uruma,Tomonori; Seita,Ikuo; Oishi,Tsuyoshi; Watanabe,Yusuke; Tsukimori,Ayaka; Haga,Yoshiteru; Fukushima,Shinji; Sato,Akihiro; Nakamura,Itaru; Matsumoto,Tetsuya

doi:10.3892/mco.2017.1244

Solitary pulmonary caseating granulomas: A 5‑year retrospective single‑center analysis

Authors:
- Hidehiro Watanabe
- Tomonori Uruma
- Ikuo Seita
- Tsuyoshi Oishi
- Yusuke Watanabe
- Ayaka Tsukimori
- Yoshiteru Haga
- Shinji Fukushima
- Akihiro Sato
- Itaru Nakamura
- Tetsuya Matsumoto
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Affiliations: Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160‑0023, Japan, Department of Infection Control and Prevention, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki 300‑0395, Japan, Department of Microbiology, Tokyo Medical University Hospital, Tokyo 160‑0023, Japan
Published online on: May 8, 2017 https://doi.org/10.3892/mco.2017.1244
Pages: 839-845
Copyright: © Watanabe et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Solitary pulmonary caseating granulomas (SPCGs) are a characteristic type of tuberculomas associated with infection with non‑tuberculous mycobacteria (NTM) and other microbes; however, their significance remains unclear. The aim of the present study was to describe the clinical characteristics of patients with SPCGs in terms of diagnosis, presence of lung cancer and treatment status. A retrospective analysis of 17 immunocompetent patients with histopathologically confirmed caseating granulomas after undergoing video‑assisted thoracoscopic surgery (VATS) was conducted at our center between 2011 and 2015. The patients comprised 10 men and 7 women with a mean age of 59.1±14.4 years. Of the 17 patients, 14 (82.4%) were asymptomatic and the lesions were discovered incidentally. In 2 patients the SPCGs were accompanied by a small satellite nodule (SPCG mean diameter, 16.2±5.1 mm). Mycobacteria, including Mycobacterium tuberculosis (11.8%), Mycobacterium avium (11.8%) Mycobacterium kansasii (23.5%) and other Mycobacterium spp. (5.9%), were isolated from 9 of the patients (52.9%). Concurrent lung cancer was present in 3 patients (17.6%). When microbial agents could not be isolated, the interferon‑γ release assay was useful for diagnosis. Positron emission tomography was not found to be useful for differentiating SPCGs from lung cancer, or for differentiating tuberculomas from NTM pulmonary nodules (NTMPNs). NTMPNs in cases of SPCGs were diagnosed more frequently in men. The findings indicate that a course of observation may be sufficient for patients in whom an SPCG from NTM (NTMPN) is identified by VATS. However, the presence of concurrent lung cancer in certain cases indicates that malignancy should not necessarily be excluded, particularly in NTMPNs, and highlights the necessity of aggressive diagnosis by VATS.

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1	Asakura T, Ishii M, Haraguchi M, Kamiyama I, Kohno M, Sakamaki H, Emoto K, Hayashi Y, Sugiura H, Kawada I, et al: Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: A case report. J Med Case Rep. 9:2382015. View Article : Google Scholar : PubMed/NCBI
2	Scott RS, Sutton DA and Jagirdar J: Lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone marrow transplant recipient: An emerging infection with fungemia and Crohn disease-like involvement of the gastrointestinal tract. Ann Diagn Pathol. 9:227–230. 2005. View Article : Google Scholar : PubMed/NCBI
3	Linz D, Kessler S and Kane J: Pulmonary caseating granulomas associated with Mycoplasma pneumoniae pneumonia. South Med J. 76:1429–1432. 1983. View Article : Google Scholar : PubMed/NCBI
4	Aoun J, Habib R, Charaffeddine K, Taraif S, Loya A and Khalifeh I: Caseating granulomas in cutaneous leishmaniasis. PLoS Negl Trop Dis. 8:e32552014. View Article : Google Scholar : PubMed/NCBI
5	Lee HS, Oh JY, Lee JH, Yoo CG, Lee CT, Kim YW, Han SK, Shim YS and Yim JJ: Response of pulmonary tuberculomas to anti-tuberculous treatment. Eur Respir J. 23:452–455. 2004. View Article : Google Scholar : PubMed/NCBI
6	Hsu KY, Lee HC, Ou CC and Luh SP: Value of video-assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma: 53 cases analysis and review of literature. J Zhejiang Univ Sci B. 10:375–379. 2009. View Article : Google Scholar : PubMed/NCBI
7	Chun EJ, Lee HJ, Kang WJ, Kim KG, Goo JM, Park CM and Lee CH: Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: The feasibility of integrated (18)F-FDG PET/CT. Lung Cancer. 65:180–186. 2009. View Article : Google Scholar : PubMed/NCBI
8	Kawate E, Yamazaki M, Kohno T, Fujimori S and Takahashi H: Two cases with solitary pulmonary nodule due to non-tuberculous mycobacterial infection showing intense 18F-fluorodeoxyglucose uptake on positron emission tomography scan. Geriatr Gerontol Int. 10:251–254. 2010. View Article : Google Scholar : PubMed/NCBI
9	Chen S, Zhou J, Zhang J, Hu H, Luo X, Zhang Y and Chen H: Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc. 25:1723–1729. 2011. View Article : Google Scholar : PubMed/NCBI
10	Watanabe H, Uruma T, Seita I, Chikasawa Y, Kikuchi R, Itoh M, Aoshiba K, Nakamura H and Oishi T: Successful desensitization therapy involving fluoroquinolone for the treatment of a solitary tuberculoma: A case report and literature review. Mol Clin Oncol. 5:117–120. 2016.PubMed/NCBI
11	Lim J, Lyu J, Choi CM, Oh YM, Lee SD, Kim WS, Kim DS, Lee H and Shim TS: Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules. Int J Tuberc Lung Dis. 14:1635–1640. 2010.PubMed/NCBI
12	Hahm CR, Park HY, Jeon K, Um SW, Suh GY, Chung MP, Kim H, Kwon OJ and Koh WJ: Solitary pulmonary nodules caused by Mycobacterium tuberculosis and Mycobacterium avium complex. Lung. 188:25–31. 2010. View Article : Google Scholar : PubMed/NCBI
13	Ashizawa K, Matsuyama N, Okimoto T, Hayashi H, Takahashi T, Oka T, Nagayasu T and Hayashi K: Coexistence of lung cancer and tuberculoma in the same lesion: Demonstration by high resolution and contrast-enhanced dynamic CT. Br J Radiol. 77:959–962. 2004. View Article : Google Scholar : PubMed/NCBI
14	Andreu J, Cáceres J, Pallisa E and Martinez-Rodriguez M: Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 51:139–149. 2004. View Article : Google Scholar : PubMed/NCBI
15	Zhan P, Xie H, Xu C, Hao K, Hou Z and Song Y: Management strategy of solitary pulmonary nodules. J Thorac Dis. 5:824–829. 2013.PubMed/NCBI
16	Sathekge MM, Maes A, Pottel H, Stoltz A and van de Wiele C: Dual time-point FDG PET-CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. S Afr Med J. 100:598–601. 2010. View Article : Google Scholar : PubMed/NCBI
17	Opoka L, Kunikowska J, Podgajny Z, Szołkowska M, Błasińska-Przerwa K, Burakowska B, Oniszh K, Rudziński P, Bestry I and Roszkowski-Śliż K: Accuracy of FDG PET/CT in the evaluation of solitary pulmonary lesions-own experience. Pneumonol Alergol Pol. 82:198–205. 2014. View Article : Google Scholar : PubMed/NCBI
18	Chalermskulrat W, Gilbey JG and Donohue JF: Nontuberculous mycobacteria in women, young and old. Clin Chest Med. 23:675–686. 2002. View Article : Google Scholar : PubMed/NCBI
19	Miller L and Hunt JS: Sex steroid hormones and macrophage function. Life Sci. 59:1–14. 1996. View Article : Google Scholar : PubMed/NCBI
20	Comer MT, Leese HJ and Southgate J: Induction of a differentiated ciliated cell phenotype in primary cultures of Fallopian tube epithelium. Hum Reprod. 13:3114–3120. 1998. View Article : Google Scholar : PubMed/NCBI
21	Jain R, Ray JM, Pan JH and Brody SL: Sex hormone-dependent regulation of cilia beat frequency in airway epithelium. Am J Respir Cell Mol Biol. 46:446–453. 2012. View Article : Google Scholar : PubMed/NCBI
22	Kim YI, Goo JM, Kim HY, Song JW and Im JG: Coexisting bronchogenic carcinoma and pulmonary tuberculosis in the same lobe: Radiologic findings and clinical significance. Korean J Radiol. 2:138–144. 2001. View Article : Google Scholar : PubMed/NCBI
23	Su VY, Yen YF, Pan SW, Chuang PH, Feng JY, Chou KT, Chen YM, Chen TJ and Su WJ: Latent tuberculosis infection and the risk of subsequent cancer. Medicine (Baltimore). 95:e23522016. View Article : Google Scholar : PubMed/NCBI
24	Higuchi K, Sekiya Y, Igari H, Watanabe A and Harada N: Comparison of specificities between two interferon-gamma release assays in Japan. Int J Tuberc Lung Dis. 16:1190–1192. 2012. View Article : Google Scholar : PubMed/NCBI
25	Mancuso JD, Mazurek GH, Tribble D, Olsen C, Aronson NE, Geiter L, Goodwin D and Keep LW: Discordance among commercially available diagnostics for latent tuberculosis infection. Am J Respir Crit Care Med. 185:427–434. 2012. View Article : Google Scholar : PubMed/NCBI
26	Kuznetcova TI, Sauty A and Herbort CP: Uveitis with occult choroiditis due to Mycobacterium kansasii: Limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity). Int Ophthalmol. 32:499–506. 2012. View Article : Google Scholar : PubMed/NCBI
27	Laisaar T, Viiklepp P and Hollo V: Long-term follow-up after thoracoscopic resection of solitary pulmonary tuberculoma. Indian J Tuberc. 61:51–56. 2014.PubMed/NCBI
28	Abe M, Kobashi Y, Mouri K, Obase Y, Miyashita N, Nakata M and Oka M: Solitary pulmonary nodule due to Mycobacterium kansasii. Intern Med. 50:775–778. 2011. View Article : Google Scholar : PubMed/NCBI